Urinary diversion in females

Abstract

Permanent urinary diversions are performed in the majority of patients after cystectomy for bladder carcinoma. An ileal conduit is the most common incontinent stoma created but long-term follow-up shows that up to 80% of patients may develop deterioration in the upper renal tract, stomal problems, pyelonephritis, urolithiasis or electrolyte abnormalities. Continent stomas require intermittent self-catheterization to empty their reservoirs, which are created from detubularized ileal or colonic bowel segments. Long-term follow-up is awaited with continent urinary diversions but the absence of a continually worn collection device is of major benefit to patients. The risk of developing colonic carcinoma and metabolic disturbances has detracted from the use of ureterosigmoidostomy as a common form of diversion, but recently the augmented valved rectum and the sigma rectal pouch have been described to minimize the metabolic changes previously described.